Electronic Media Essay

Electronic media  are  media  that use  electronics  or  electromechanical  energy for the  end user  (audience) to access the content. This is in contrast to static media (mainly  print media), which are most often  created electronically, but don’t require electronics to be accessed by the end user in the  printed  form. The primary electronic media sources familiar to the general public are better known as  video recordings,  audio recordings,  multimedia presentations,  slide presentations,  CD-ROM  and  Online  Content. Most  new media  are in the form of  digital media. However, electronic media may be in either  analog  or  digital  format. Although the term is usually associated with content recorded on a  storage medium, recordings are not required for live  broadcasting  and  online networking. Any equipment used in the  electronic communication  process (e. g. television,  radio,  telephone,  desktop computer,  game console,  handheld device) may also be considered electronic media. USES : Electronic media are ubiquitous in most of the developed world. As of 2005, there are reports of satellite receivers being present in some of the most remote and inaccessible regions of China. Electronic media devices have found their way into all parts of modern life. The term is relevant to  media ecology  for studying its impact compared to printed media and broadening the scope of understanding media beyond a simplistic aspect of media such as one delivery platform (e. g. the World Wide Web) aside from many other options.

PostQuick Computing project Essay

I designed my project on visual basics 6. 0, and the benefit I found in Visual Basics as compared to other software was that Visual Basics is user friendly. Anyone can use it by clicking certain buttons, and on the other hand other software packages such as Microsoft Access and Microsoft Excel require a bit of knowledge before using them. To make my own project using visual basics, I first designed my form on the paper, which gave me a rough idea about how my project form would look like. This is also attached with my documentation. I designed my project by prototyping, and made my form using these things   A set of screen that shows the user what might be possible   A system with limited functionality An existing system that might be modified For my human-computer interface (HCI), I used graphical user Interface (GUI) which is used in Microsoft windows . My form had certain buttons which could be used by clicking the mouse and some text boxes in which data was entered using keyboard. I think that the advantage of this type of interface is this that It is easy to use   In my form no one needs special instruction The disadvantage of GUI is   It uses a lot of processing power   It requires good graphical display   It uses a lot of processing power   It uses a lot of memory and disk space 3. Method of Data Entry, including Validation As said before that my form had certain buttons and these buttons could be used by clicking the mouse and some text boxes in which data was entered using keyboard. I declared each data type with certain specific data type, and checked that if I entered wrong data type then it would not work. The method of data entry is also shown in implementation. The program contains three forms. The main form, which is named input form, is the start-up form. This is the data entry form for all the data, which is entered for a particular assignment. The method of entering data is as follows. Consignment No: These are self-generated. Numbers, its enabled property is false. User has no control on entering its data. Customer Name destination and client address will be entered in respective columns. Afterwards the information of the first parcel of the consignment will be filled (i. e. the whole form will be filled). If there are more then one parcel required to be entered for the same consignment then add new parcel button is pressed for the parcel, and after each parcel entry of the consignment† data entry complete† button will be pressed For a separate consignment†new consignment button â€Å"is required to be pressed. It was part of validation of the project that, the minimum weight of the parcel should not be less then 1 kg. If it does then the message box would appear saying that too less weight in the parcel. Second validation was that the weight of the parcels should not exceed 30 kg, if it does then the message box would appear saying, too much weight of the parcel† The third Validation was that the maximum dimension of the parcel i. e. (length + breadth + height) must not exceed 3 m, if it does then the message box would appear saying â€Å"too big Parcel to send†. The fourth validation was that the maximum weight of consignment must not exceed 200 kg, if it does then the message box would appear saying† too much weight of the consignment† 4. Record structure, file organisation and processing:- The file for the database of the consignments for the Parcel Company is saved as a record structure and saved only for the consignments for one day. It includes the data and information required for the parcels in consignments. It is a record file so it cannot be changed, but the database is changed everyday because each day different consignments are sent to the Parcel Company. The database is linked with Visual basics form, and the file of database is stored as a Microsoft access file. For the backup the file is saved in the floppy so if the actual program in the processor is altered, we can bring back the old one. There are four files that I used for my project one was the form file, named as input parcel, and two forms were for the price list, the Access file linked to database, named as, payslip database which has two databases linked to each other. The actual processing carried out by the program is arithmetic operation, in other words calculation is being carried out, but the bigger companies can use CLOCK SYSTEM, which would be more economical for them. 5. Security and integration of Data Security is the most important thing, because if your data is not secured properly from unauthorised hands then anyone could change your data and could change your project; I therefore kept the project under a password So no one could change or alter my project. If someone did change my database then I could use my backup to restore it from the floppy in which I’ve kept the backup file so if the actual program in the processor is altered, we can bring back the old one. I also protected my data, by using the menu button in the visual basics. If you go to the text box, u click on it and then click text box protect enable force and in this way I can protect my text. I also made sure that when data is entered it is entered accurately and I checked that when I was entering data, no one enters anything. 6. System design:- For documenting my project I used System flow charts-It describes the flow of data around the system. This method uses rectangle to denote some process that takes place, as descriptive symbols to describe the storage or input/output of data. An arrow describes the direction of flow of the data.   Structure diagrams-These are a mean of showing the design of a program or a systemic consists of charts showing the system or programs broken down into number of levels. * Hierarchy charts-these can be used to show menu hierarchy or a directory hierarchy Data model:- A data model represents the relationship between different parts of a database. It consists of entities (data items) and relationship. The entities are shown as rectangles and the relationship are drawn as lines that connect entities. System Flow Chart (describing the flow of data around the system) Parcelquick Company Aqsa Bano Raja 12 s Postquick Structure Diagram The hierarchy Hierarchy diagram 7. Implementation The project that I have made for PostQuick Company can be implemented either as a whole or in parts. The problem maybe that an organisation cannot change instantly to a new method of working as existing records will have to be entered into computer and this may take some time. There are two main approaches to this   Implement the system department by department   Dual run the new system alongside the old system The two databases below are linked to Visual basics6. 0 forms 8. Testing Length,width,height,weight Test Results Right/wrong.

Gothic Literature: the Fascination with Terror

Traci L. Pugh Dr. Amber Reagan-Kendrick ENG 45023-SU-2012-OA Seminar in American Literature 8 August 2012 Gothic Literature: The Fascination with Terror People have an intrinsic fear of the dark and the unknown. While each person’s level of anxiety and object of terror are different, the fascination to reveal them has inspired Gothic authors such as Mary Shelley, Edgar Allan Poe, Stephen King, and Stephenie Meyer for three centuries. Subjects of these classic tales include vampires, reanimation of the dead, ghosts, murder, witches, and love.These stories and poems can terrify audiences because they can encompass reality of things people cherish with a twist of the impossible. Gothic writers use terror, mystery, and excitement to probe the dark aspects of life by exposing inner human fear. Mary Shelley was a Romantic Gothic author, and it is speculated that Frankenstein symbolizes â€Å"internal conflicts and life experiences with what may have been their manifestations in the fictionalized characters she created† (D’Amato 117). She was orphaned at an early age, and death was no stranger to her due to the deaths of her sister and her husband’s first wife.Mary feared giving birth, mainly because her mother died eleven days after giving birth to her, but D’ Amato proposes that she â€Å"may have believed any child she produced would inherit the repressed, hated, and destructive parts of herself† (122). Shelley’s work may have mirrored her life, but it was common for Gothic authors of this time to write about â€Å"the nation’s dreams, and their own† (â€Å"Gothic Undercurrents†). The early nineteenth century was a time of fear due to rapid changes in the nation: abolition, the Great Depression, war, and the bank crisis.These events gave Americans the feeling that â€Å"life was an experiment that had gone horribly wrong,† and these writers explored this fear with prose (â€Å"Gothic Unde rcurrents†). This newfound style of writing exposed the dark side of humanity, but it also questioned the mystery of unsolvable problems. These works probed the demons of the nation and the writers. Frankenstein began as Mary Shelley’s dream in 1816, and her tale of loneliness, reanimating the dead, murder, guilt, and revenge has been dubbed a literary classic.The main character, Victor Frankenstein, believes he has discovered the secret of life and proclaims, â€Å"Darkness had no effect upon my fancy; and a church-yard was to me merely the receptacle of bodies deprived of life, which, from being the seat of beauty and strength, had become food for the worm† (Shelley 79). Once the monster is created, it feels abandoned and starts killing. The creature inadvertently causes the death of an innocent girl. Victor realizes his creation is lonely, and nothing more than an abomination, so he decides to destroy it.A journey into the mountains ensues, but a crack in the ice divides their paths. When Frankenstein dies, the monster comes to see him and says, â€Å"Blasted as thou wert, my agony was still superior to thine; for the bitter sting of remorse may not cease to rankle in my wounds until death shall close them for ever† (Shelley 244). This story reveals the idea that the dead, once reanimated, are like an angry child who lashes out at a parent who has betrayed them. The feeling of abandonment was what Shelley tried to capture in this morbid tale of love and loss, and this theme would continue with future authors.Edgar Allan Poe, considered a Victorian Gothic, was also an orphan whose life seemed to be full of disaster. He suffered an unmerciful surrogate father, was kicked out of the University of Virginia, dropped out of West Point, married his thirteen year old cousin, and lived in poverty with his freelance lifestyle (Doctorow 241). The driving force behind his work was that he embraced his own misery because he believed that his s uffering was natural. His stories were written in the mid-nineteenth century, and people were still afraid of their uncertain futures.Poe used this to his benefit in what he called, â€Å"Imp of the Perverse – the force within us that causes us to do just what brings on our destruction† (241). This kind of thinking was the basis for many of his stories, and most of his characters were the reason for their own problems and demise. Poe â€Å"worked hard at structuring his tales of aristocratic madmen, self-tormented murderers, neurasthenic necrophiliacs, and other deviant types to produce the greatest possible horrific effects on his readers† (Baym 674).He was quite successful in this endeavor, as most people associate Poe’s name with dark, horrific, murderous tales. His â€Å"Philosophy of Composition† tells of his belief that â€Å"the supreme subject for a poem is the death of a beautiful woman† (Doctorow 242). This is evident in one of his most famous poems, â€Å"The Raven. † Possibly one of Poe’s most maddening poems, â€Å"The Raven† is rhythmic and could be set to music with constant mention of the door, Lenore, evermore, and nevermore. The use of vivid imagery causes the reader to see this black raven sitting on the door pecking at it.The main character is a man grieving for his lost love, Lenore, and he believes the knocking sound is her returning. The raven says but one word, â€Å"Nevermore. † The man wonders what this means, and asks the bird if it is a messenger from God or the devil. Again the Raven says, â€Å"Nevermore. † Spiraling into madness and grief, he begs the bird, â€Å"Take thy beak from out my heart, and take thy form from off my door. Quoth the Raven, ‘Nevermore’† (Poe 74). The Raven stays at the door and forever torments the man with his repetitive call.This uncertainty about death was a Gothic specialty, and the introduction of animals and their mysterious qualities would prove to inspire future writers. A century later, tales of Modern Horror would build on their macabre roots and incorporate popular culture to terrify readers like never before. Stephen King, often named the master of horror, has petrified audiences with tales of demonic cars, possessed children, undead pets and people, aliens, and the inherent evil in all people. King’s inspiration stems from â€Å"his own life experiences and fantasies, popular culture, and his reading of archaic burial lore† (Nash 151).Even though most literary critics do not agree with his writing style, horror fans are mesmerized by the images he creates. King and Shelley both play on fears â€Å"such as the problematic nature and popular fear of science and technology† (151), but King is â€Å"more willing to tackle explicitly cultural issues as opposed to the traditional Gothic preoccupation with personality and character† (152). Many of Kingâ⠂¬â„¢s stories concentrate on a fear of the dead, but they also raise the question of whether the dead want to come back and the consequences that follow.Love is a powerful thing and people never want to let go of a loved one, but at what expense are they willing to have that person back? Stephen King’s scariest tale, Pet Sematary, asks and answers this very question by illustrating a modern family and the horrific, yet normal, happenings that tear the family apart and invoke the need for the supernatural. The Creeds move to a new house in Maine to start a new life. Mr. Creed is a doctor at the University, and he befriends the old neighbor next door. The neighbor tells of an Indian burial ground beyond the pet cemetery where the dead can come back.The family cat, Church, is killed by a truck on the busy road in front of the house, and Mr. Creed desperately buries the body in the â€Å"magic circle† of the burial ground to keep from telling this horror to his daughter. The cat comes back to life, but is â€Å"changed, if not psychotic† (Nash 156). Soon, the youngest son, Gage, meets the same disastrous fate as the cat. The father is consumed with grief and frantically buries the little boy in the same place. Gage comes back in the same fashion as the cat and kills his mother and the neighbor.Even though the father is a doctor, and knows what the monster that resembles his son is capable of, he again makes a journey to the burial ground to bury his wife. He sits and waits for her to arrive. Love makes people desperate and willing to cross unrealistic boundaries in order to escape pain. Writers have used the connection between love and death to explore new avenues in horror. Stephenie Meyer has spellbound audiences with her Twilight series by introducing us to a world of supernatural beings, jealousy, ancient pacts, and love.Much like her Gothic predecessors, Meyers uses her dreams and popular culture to inspire her tales. Her vampires differ from the earlier versions in that â€Å"our vampires reflect our fears of new, changing or dissolved boundaries† (Mutch 76). New topics, such as â€Å"violent intolerance in the U. S. and elsewhere† are revealed by her characters going â€Å"to great lengths to hide their true identity† (78). This new generation of creatures reflect the thirst for blood and supernatural strength of the original monsters that began this era, but a regard for human life sets these apart.The overall view of the Twilight series, by Stephenie Meyer, is that love conquers all, even death. Much like Gothic literature itself, this story involves centuries of vampires hiding from the light to maintain existence among their prey. The human girl, Bella, is in love with a vampire, Edward, and they know that being together is impossible. She is willing to end her life and join his dark world, but he is unwilling to claim her mortality. In the same spirit as Frankenstein, Edward sees his cre ator as a father figure, but laments his own vile existence.It is revealed that her best friend, Jacob, who is also in love with her, is a werewolf. The vampires and the werewolves have a pact, but it will be breached if Bella joins the vampires. There are constant struggles between the humans, vampires, and the werewolves, but the undying love between Bella and Edward is unyielding. The two finally marry, and a baby is conceived that almost kills Bella. Although he has fought it diligently, Edward is forced to ferociously inject his venom into her lifeless body to save her in childbirth.The baby is half vampire and human, and instantly demonstrates supernatural powers, and captivates Jacob, which ends the battle between the coven and the clan. The book ends with a glimpse into the beauty of becoming a vampire when Bella remembers the first moments after she wakes as a newborn vampire: â€Å"his face when I’d opened my eyes to my new life, to the endless dawn of immortality . . . that first kiss . . . that first night . . . † (Meyer 753). The Twilight series is a love story with interjections of paranormal powers and the desire to want the things that cannot be obtained.This tale has consumed many and launched the â€Å"Twihard† generation. Meyer made vampires and werewolves vicious and bloodthirsty, but beautiful; unlike their nineteenth century counterparts, who burst into flames in the sunlight and transformed into hideous, drooling monsters, these beautiful creatures glitter in the sunlight and resemble overgrown dogs. Although Meyer made this less horrific than older horror stories, her series encouraged younger generations to discover the beauty of literature again. Stephen King once said, â€Å"Death is a mystery, and burial is a secret† (9).Although it is often grotesque, demonic, and depraved, people have an inherent need to explore the divide between good and evil, the known and unknown, and this world and the next. These tales have endured, yet changed, over the last three centuries. Future writers of the macabre will most assuredly follow in their predecessors’ footsteps and adapt to cultural changes in their own style. As long as people have inner demons, there will be a need for writers to expose them. Even though these horror classics are classified as fiction, what makes them terrifying is that they mimic the reality of everyday life. Works CitedBaym, Nina, ed. â€Å"Edgar Allan Poe. † The Norton Anthology of American Literature. 7th ed. Vol. 1. New York: Norton, 2008. 671-674. Print. D’Amato, Barbara. â€Å"Mary Shelley’s Frankenstein: an orphaned author’s dream and journey toward integration. † Modern Psychoanalysis. 34. 1 (2009): 117-135. Web. 7 Aug 2012. Doctrow, E. L. â€Å"Our Edgar. † Virginia Quarterly Review. 82. 4 (2006): 240-247. Web 7 Aug 2012. â€Å"Gothic Undercurrents. † American Passages: A Literary Survey. Annenberg Learne r, n. d. Web 7 Aug 2012. King, Stephen. Pet Sematary. 1st ed. New York: Doubleday & Company, Inc. , 1984. Print. Meyer, Stephenie. Breaking Dawn. st ed. New York: Atom Books, 2009. Print. Mutch, Deborah. â€Å"Coming Out of the Coffin: The Vampire and Transnationalism in the Twilight and Sookie Stackhouse Series. † Critical Survey. 23. 2 (2011): 75-90. Web. 7 Aug 2012. Nash, Jesse. â€Å"Postmodern Gothic: Stephen King’s Pet Sematary. † Journal of Popular Culture. 30. 4 (1997): 151-160. Web. 7 Aug 2012. Poe, Edgar Allan. The Complete Tales and Poems of Edgar Allan Poe With Selections From His Critical Writings. Expanded. New York: Barnes & Noble, Inc. Alfre A. Knopf. Inc.. 1992. Print. Shelley, Mary. Frankenstein. 2nd ed. Ontario: Broadview Press, 1999. Print.

Dunns Emporium Experiences Growth Research Paper

Dunns Emporium Experiences Growth - Research Paper Example Leadership is the process of motivating, empowering, influencing and communicating with people to achieve organizational goals in a given situation. The role of a leader is to encourage the team to work towards the goal, define the task by providing a structure, classify the decorum, policies and the working methods for the team and evaluate the performance to enhance the individual development of the team. Therefore a leader motivates, encourages, guides creates followers, controls, negotiates and inspires the team for quality performance achievement. Joseph Dunn needs to act as a motivator and encourage the staff of Dunns Ski Emporium and The Deli to acknowledge his decision of the merger. He would act as a mediator to enable consensus among the employees. He must act as an initiator to promote innovation that can be brought in the strategic implementation of both the firm’s growth. His role as a strong leader is important to assure complete harmony among the employees of th e firm by integrating the departments. He must implement working methods and behavioral conduct as well as facilitate ideas from a team which was a problem being faced in The Deli due to the new ice-cream manager, John Levitz as his arrogant behavior towards his subordinates were inappropriate and was discouraging the team to perform and coordinate among themselves.On the other hand, John was young and enthusiastic about the expansion of the ice-cream business which would benefit from the merger of the two firms.

Peter Alexander Promotional Plan Essay Example | Topics and Well Written Essays - 2250 words - 1

Peter Alexander Promotional Plan - Essay Example It is evidently clear from the discussion that target audience is subdivided into three categories. Differing products are to be designed for each target market. The markets include teenagers, young adults, couples, and kids. Members of all of these audiences shall be satisfied via product differentiation. The marketing mix of the Peter Alexander shall be representative of its overall strategy. Products shall be designed in ways that are differentiable and aimed towards the specific target market. Placement shall be done strategically and strong third-party ties with distributors shall be ensured to ascertain the timely distribution of products to customers all across the country. Promotion shall be done through ATL and BTL. The cost-effective medium of internet shall be the key communication strategy as it can attract customers immediately online and does not add much to the costs. The firm shall use creativity by using the image of Peter Alexander as the brand persona and exploitin g the internet for this purpose. Peter Alexander is an exclusive brand of nightwear that has operations centralized in Australia. Peter Alexander, the man himself, personifies the brand and serves as a symbol for the company. The company has a high brand equity with its followers due to the exclusivity showcased by Peter Alexander. The brand idea came into being when Peter bought a pair of Pajamas in Hong Kong. He was startled by the way in which he was attracted towards them and wanted to identify ways to make these products appeal to other people around him. Today Peter Alexander is one of the top sleepwear brands in Australia and from an online business, it has expanded into stores and continues to operate online.

Film Schindler's List Movie Review Example | Topics and Well Written Essays - 2500 words

Film Schindler's List - Movie Review Example chindler' Lit i not jut a biography of Okar chindler, but it i the tory of how good can overcome evil and how charity can overcome greed. (Paldiel, 2007) chindler' Lit begin with the early life of Okar chindler. The novel decribe hi early family life in the Autro-Hungarian Empire, and hi adolecence in the newly created tate of Czecholovakia. It tell of hi relationhip with hi father, and how hi father left hi mother. Hi mother i alo decribed in great detail. Like many German in the outh, he wa a devout Catholic. he i decribed a being very troubled that her on would take after her etranged huband with hi negligence of Catholicim. Okar never forgave Han, hi father, for hi abandonment of hi mother , which i ironic conidering that Okar would do the ame with hi wife Emilie. In fact Han and Okar chindler' live would become o much in parallel that the novel decribe their relationhip a "that of brother eparated by the accident of paternity." Okar' relationhip with Emilie i alo decribed in detail a i their marriage. The heart of the novel begin in October 1939 when Okar chindler come to the Polih city of Cracow. It ha been ix week ince the Ger man' took the city, and chindler ee great opportunity a any entrepreneur would. For chindler, Cracow repreent a place of unlimited poibilitie becaue of the current economic diorder and cheap labor. Upon hi arrival in Cracow he meet Itzak tern, a Jewih bookkeeper. chindler i very impreed with tern becaue of hi buine prowe and hi connection in the buine community. oon chindler and tern are on their way to the creation of a factory that would run on Jewih labor. Around thi time, the perecution of the Jew of Poland begin with their forced relocation into ghettoe. Thi turn out to be timely for chindler a now he i able to get very cheap labor. (Fench, 1995) The next few year would go well for chindler and hi factory for they turned a great profit. In fact he made o much money that he i quoted a aying, "I've made more money than I could poibly pend in a lifetime." Hi worker were alo very happy. Thi i becaue "chindler' Jew" were treated a human a oppoed to being treated a animal. For them, working in chindler' factory wa an ecape from the ghetto and from much German cruelty. They loved chindler o much that hi factory became known a a haven throughout the Jewih community. However, thing began to go our for chindler, when the German ordered the liquidation of the ghettoe. oon all of the Jew in the Cracow ghetto were relocated to the Plazow labor camp. By thi time chindler had grown o affectionate toward hi Jewih worker that he refued to hire Pole, and intead ought of a way to keep uing the Jew that he had grown o accutomed to. A the Cracow Jew were relocated to the Plazow labor camp, Okar chindler came into direct dealing with the camp' dir ector, Amon Goeth. He did not like Amon, but he tried to get in on hi bet ide in order to keep uing hi Jew in hi factory. Amon agreed to let chindler ue them, and thu aving hi Jew from ome of the harhne of the Plazow labor camp. A the war began to go badly for the German, they decided to accelerate their "final olution" by ending the Jew to more initer concentration camp uch a Auchwitz. Thi i when Okar chindler finally come to the realization that he had the power to help hi people. (Yule, 1997) The now enlightened chindler decide to ue hi entire fortune to

Case Study 6 Essay Example | Topics and Well Written Essays - 750 words

Case Study 6 - Essay Example The most probable symptoms exhibited by the community people living with AIDS include swollen glands growing in the throat and groin. Further, the individuals may also witness muscle aches and fatigue. Normally, the fatigue and tiredness period are usually unexplained in this people. It is worth noting, that everyone in the New York community is susceptible to contracting the virus. In which case, anyone who involves in unprotected sex and sharing of infected equipments is at risk of contracting the disease especially if any of those involved another party who is HIV positive. Considering AIDS is transmitted through body fluids, sharing of the sharp equipment and having coitus with the infected person is a most certain way the virus can spread. The virus normally presents itself in blood, semen and breast milk of infected people (Timberg & Halperin, 2013). These are the most common ways that AIDS presents itself in New York city, where there are people from all walks of life. Once the virus is introduced to the bloodstream, it affects the immune response thereby reinforcing its symptoms on the body of the infected. Apart from New York city, other communities that have witnessed the same include Los Angeles, Chicago, Houston and Philadelphia. This is because of t he higher population growth in this areas. Even though AIDS has manifested itself as pervasive in the above communities, the involved subjects have been able to manipulate strategies for preventing the disease. Naturally, the pervasiveness of the disease arises because the communities have failed in their attempts to get a cure or vaccine. However, the efforts put have given rise to such strategies such as the need to avoid the high-risk behaviors, including unprotected sex and sharing of sharp instruments. Further, the subject healthcare providers in this

Sleeping disorders Research Paper Example | Topics and Well Written Essays - 1250 words

Sleeping disorders - Research Paper Example On identifying, the causes of sleeping disorders can help you find solutions and enhance your sleeping patterns (Mayo Foundation par. 1). This is the most common sleep disorder experienced by most people. A person suffering from insomnia does not get the right amount of sleep necessary to keep rested or refreshed. A number of factors including stress, nervousness, depression or any health problem can cause insomnia. In addition, it can also occur because of lack of exercises, lifestyle choices and jet lack or consumption of a given food or drink such as increase in coffee intake (Kalimoet al. 65). A person suffering from insomnia may have difficulty in sleeping during the night or upon waking up during the night he or she will have trouble in resuming back to sleep. The person may also have the problem of waking up very recurrently during the night as well as having a very light sleep. The person may also require something to fall sleep and during the day, he can feel sleepiness and low body strength (Ford and Lisa 3). This causes an irresistible desire to move legs when sleeping. It occurs because of lack of comfort, tingling, ache and creeping sensation (Chervin 1185). The affected person will thus experience scratchy sensations cavernous within the legs and a strong desire to move. The movement of the legs tends to relieve the person from the sensations and the person will be repetitively jerking his legs when asleep (Walterset al. 634). Excessive, unmanned sleepiness during daytime are the common characteristics of this sleep disorder. It comes because of malfunction of the part of the brain that determines sleeping and waking. A person with narcolepsy sees things when starting dream and often feels weak and loses control of his muscles when laughing. He may also experience easy dreams even when he just starts sleeping and

What explains today's high degree of global financial integration Essay

What explains today's high degree of global financial integration - Essay Example lobal integration in the financial market has given the opportunities to the investors to diversify the risks and to access the financial products in a more easy way. (Agarwal, n.d.) The functionalities of the process of globalization has been motivated by heterogeneous factors, such as gradual increase of trade in goods and services, increase of free movement of capital across international borders, increase of international mobility of labor and increase of global technological transfers. The impact of international movement of capital and global financial integration on the developing countries experienced a dramatic change in the early 1990s with the enhancement of financial deregulation in many countries. (Wolf 2005) This is the period when the free capital movement from the developed and industrial nations to the developing nations had started to rise vividly which was seen through the increase in growth of the developing nations. However, during this era the globe has also seen a sequence of financial crises across many countries. In one hand many developed countries faced the financial crises, such as the 1992 and 1993 financial crises of the developed c ountries in the European Exchange Rate Mechanism (ERM). On the other hand the developing nations also faced such crises, like the Mexican Tequila crisis in 1995, 1997 and 1998 Asian crises, the Latin American and the Russian crises from 1998 to 2000 etc. All these crises that were seen throughout different part of the globe gradually proved that there lies an inherent risk of the international financial integration behind its benefit. The international financial integration through the opening of the cross border financial markets is a multifarious phenomenon that involves in unrestricting the movement of foreign direct investment (FDI) from the developed countries to the developing countries and pulling up the regulations from both the short term and long term financial instruments which are responsible

Teacher as a Learner Essay Example | Topics and Well Written Essays - 500 words - 1

Teacher as a Learner - Essay Example First, teachers have a responsibility both to students and the professional teaching community they are part of. Thus, professional development in both aspects must be implemented in order to improve the teacher as educator through increasing their subject-matter knowledge, and teaching them ways to learn, teaching them how to make education more enjoyable, and encouraging critical thinking, which they can pass on to students; and as professionals by strengthening their professional knowledge to aid in teaching. All of which fosters continuous improvement and self-renewal on the teacher as an individual, allowing the teacher to be a better member of the professional community and classroom he is part of. Second, teachers, as part of an overarching educational system must support education reform strategies and implement them in the classroom. However, since reform is only as effective as its implementation, teachers as learners must understand how to appropriately and properly integr ate reform initiatives into their classroom. Only through appropriate and proper integration can reform initiatives successfully achieve desired learning outcomes such as enhancing learning capabilities of students, encouraging higher level thinking, fostering creative thinking and open-mindedness, and allowing students with exceptional needs to fully participate in class. Moreover, teachers must also learn to be creative and take risks in designing how education reform strategies will be implemented in the classroom. Lastly, it is important for teachers to treat the classroom as a learning environment and become a cooperative participant actively questioning to elicit greater participation from students, as opposed to an authority figure. By doing so, students are given more opportunities to learn and express themselves. Consequently, teachers are given more opportunities to observe,

Sales Management&The Salesman Essay Example | Topics and Well Written Essays - 500 words

Sales Management&The Salesman - Essay Example They are explained below. Any manager or a person who is an essential part of a company will want maximum utility of their product. When the salesman sold the most expensive and top-of-the-range software to a 2-man antique shop then the product was way beyond their needs since they needed a simple accounting software and people have a habit of talking bad about a product when it is of no use to them. Since word of mouth is a very string advertising technique that decides the success or failure of a company. It can turn a star product into a useless dog if let loose or not used effectively. Since there is no coming back in this technique because once the company's image goes down the drain the effects are fatal. Another reason can be the irresponsibility of the salesman. A good salesman must think out of the box and it is their duty to help the customer find the best product. If the salesman is able to attract the customer with his skills then the next step is influencing the customer enough to create brand loyalty. Further brand loyalty can be cashed at every step of the selling process. But the salesman in this case, being a star salesman for some reason failed to fulfil this requirement. Lastly, such blunders can spoil the brand image of the company.

Shutter Island Essay Example for Free

Shutter Island Essay This movie was confusing from the beginning, Edward Teddy Daniels a previous World War II veteran whom suffers from Post-Traumatic Stress Syndrome and constantly has flashbacks. Shutter Island follows U.S. Marshall Daniels and his partners Chuck Aule while the investigate the disappearance mental patient from Ashecliffe Hospital for the Criminal Insane. Teddy requested the assignment for personal reasons. But he wonders was he hasn’t been brought to the island and conspiracy. Fire is an symbol for Teddy whole existence every time Teddy is around (ex. The matches he lights in Ward C) the fire in the cave with Dr. Solando and when he starts an fire and blows up Dr. Crawley’s car. He constantly played with fire that burnt down his own apartment killing four people one of which was his own wife Dolores Chanal. He has produced this whole conspiracy theory that somehow the government has begun doing experimental testing on patients at the asylum. In reality Teddy has been declared insane and was sent to Shutters Island. Upon arriving at the institution. Teddy is the subject of the experiment; the doctors attempt to have Teddy regain his life back. Dr. Crawley and Dr. Sheehan began implanting false memories into Teddy’s mind. Teddy is delusional claims that he is an U.S. Marshall to justify his own presence. Dr. Crawley who invented Racheal Solando for him to discover what happen to the 67 patient which is actually Edward (Teddy) Daniels. Teddy’s partner who is really Dr. Sheehan is in on the experiment he tries to steer Teddy in right direction. He encourages Teddy to continue the hunt he tries to push fear on Teddy by even taking him to an Mausoleum. And he is always playing with Teddy whether its real or delusional He even gives Teddy an admission form that says it’s really 67 patients at the asylum so Teddy’s Feel that he has to find Racheal whom is supposedly escaped which she really turns out to be a nurse whom has treated Teddy while he has been a patient at Ashecliffe Hospital. While on the hunt for the missing patient Teddy encounters different obstacles. Dr. Crawley and Dr. Sheehan are is slowly taking Teddy off his meds so he starting to feel body tremors and withdrawals. Sheehan and Crawley began to monitor his doses for the role playing experiment in the film Teddy begins to have more vivid hallucinations while he’s awake his meds are meant to suppress all types of psychosis not to trigger more going off the meds make Teddy really unsteady. When Teddy reaches the lighthouse he is confused and is starting to second guess everything that he has been going through. He has developed his own explanation. Though it was an complete delusional fantasy. At this point the experiment is judged to have failed or succeeded , If Teddy accepts this fabricated account that the Drs. Have succeeded in attempting to implant a false memory. Teddy has been through this before and realizes that there is no way out Shutter Island Teddy struggles with being Lobotomize but reconsiders and decides that lobotomy would be better than chasing Andrew Laeddis for the rest of his life he figure they’ll just try to keep forcing the Lake House, Racheal Solando, and the other delusions he was having over and over again. Teddy made the choice to take the lobotomy and thus die a good man. â€Å"It is better to live as a monster or die a good man†. He refuses to accept the reality that he was just a an maintenance man who love to play with fire whose wife died because of this, and is stuck in a delusion in which he is Teddy Daniels an U.S. Marshall hunting down a suspected killer Andrew Laeddis an false identity other than a man that killed his wife. Throughout the entire movie the audience is caught up in the Teddy story thinking that he is actually sent to the island to find a suspected escapee. Even his flashbacks trigger the watcher to think Teddy has really had a hard life losing his children, killing his beloved wife whom the audience thought she actually killed the children which causing Teddy is become an alcoholic. Unbeknown to the watcher Teddy is playing the role of a functioning adult whose is trying desperately trying to figure up what is really happening on Shutter Island. The Drs. are trying so hard to get a major breakthrough with medicine by giving the opportunity to reenact his own fabricated story. The viewer is rooting for Teddy only to realize he is leading them a on wild goose hunt because in fact he is insane and can’t grasp the concept on reality what’s real, fake, makeup, or just plain lunacy. One question are there two possible endings were Teddy and Andrew possibly real was Teddy really married was a government it coverup did Teddy knows too much about the Nazis and espionage? This moving was scaring at the same time interesting because it is an movie one would possibly have to see more than once to get an complete understanding.

Classification According To Maturity Biology Essay

Classification According To Maturity Biology Essay INTRODUCTION The human eye is very nearly spherical, with a diameter of approximately 24 mm (nearly one inch). It consists of three concentric layers, each with its own characteristic appearance, structure and functions. From outermost to innermost, the three layers are the sclera, which protects the eyeball; the choroid, which nourishes the eyeball; and the retina, which detects light and initiates neural messages bound for the brain. The eye is partitioned into two chambers, a small anterior chamber and a larger vitreous chamber. Thus the basic layout consists of three concentric layers, two chambers, iris, pupil and the lens (Ross and wilson, 2001). Fig.1 Anatomy of the eye C:UsersDHINESHDesktopUntitled1.png The Lens One of very important optical element of the eye, the crystalline lens, lies right behind the iris. The lens takes its name from its resemblance to a lentil, or bean. In adults, the lens is shaped about 9 mm in diameter and 4 mm in thickness. The lens consists of three distinct parts: an elastic covering, or capsule; an epithelial layer just inside the capsule; and the lens itself. The thin, elastic capsule around the lens has two jobs. First, it moderates the flow of aqueous humor into the lens, helping the lens retain its transparency to light. Second, the elastic capsule moulds the shape of the lens varying its flatness and, thereby, the lens optical power. This variant in optical power is called accommodation. Lens grows throughout the life span; the outer, epithelial layer of lens continues to produce protein fibres that are added to the surface of the lens. Consequently, those protein fibres nearest the centre of the lens are the oldest (some were present at birth), whereas the fibres on the outside are the youngest. Between birth and 90 years of age, the lens quadruples in thickness and attains a weight of 250 mg. In the centre of the lens, the old fibres become more densely packed, producing sclerosis, or hardening, of the lens (Paterson, 1979). For good vision, the lens must be transparent and light must be able to pass through it easily, without loss or deviation. Like the cornea, this transparency depends on the material out of which the lens is made. Of all the bodys parts, the lens has the highest percentage of protein, and its protein fibres are lined up parallel to one another, maximizing the lens transparency to light. Anything that disturbs this alignment such as excess fluid inside the lens reduces its transparency. An opacity (or reduced transparency) of the lens is called a cataract. While some cataracts are minor, barely reducing the transmission of light, others undermine vision to the extent of blindness (Kyselova, 2004). Cataract Cataract is the opacification and crystalline formation of eye lens, associated with the breakdown of the eye lens micro-architecture, which interferes with the transmission of light onto the retina. Several biochemical processes for example, calcium deposition, oxidative stress, phase transition, altered epithelial metabolism, crystalline precipitation, calpain-induced proteolysis and cytoskeletal loss takes place during the development of cataract (Moghaddam, 2005). Fig.2 Normal, clear lens Fig.3 Lens clouded by cataract C:UsersDHINESHDesktopUntitled.png Fig.4 Etiology of cataract (Jacob, 1999) C:UsersDHINESHDesktopUntitled.png TYPES OF CATARACT A. Acquired cataract 1. Age related cataract a) Morphological classification i) Subcapsular cataract Anterior subcapsular cataract mainly associated with fibrous metaplasia of the epithelium present below the lens capsule. Posterior subcapsular cataract lies just in front of the posterior capsule and a clear vacuolated, granular or plaque-like appearance. Near vision is also most often impaired more than distant vision. ii) Nuclear cataract usually begins as an amplification of the changes most often seen with normal aging lens nucleus. It is often related with increased spherical aberration and also with an increased refractive index leading to myopia. Some elderly patients may consequently be capable to read yet again without spectacles. iii) Cortical cataract may be associated with the anterior, posterior or equatorial cortex. The opacities begin as clefts and vacuoles between lens fibres because of hydration of the cortex. Both cortical and subcapsular cataracts are white on oblique illumination and show black colouration, silhouetted against the red reflex, on retroillumination. b) Classification according to maturity i) An immature cataract means partially opaque lens. ii) A mature cataract means completely opaque lens. iii) A hypermature cataract means the leakage of water from the lens it leads to wrinkled and shrunken anterior capsule. iv) A morgagnian cataract means the total liquefication of lens cortex like hypermature cataract and it allows the lens nucleus to shrink inferiorly (Hejtmancik, 2004). 2. Presenile cataract Cataract may develop early in the following conditions, a) Diabetes mellitus Typically diabetic cataract is rare. In hyperglycemic conditions, the aqueous humor secretes high level of glucose and this excess of glucose diffuses into the lens. Aldosereductase metabolises glucose to sorbitol, which then accumulates in the lens, resulting in secondary osmotic over hydration of the lens substance. Nuclear opacities are common and tend to grow rapidly. Premature dystrophy may be seen due to decreased pliability of the lens. b) Myotonic dystrophy About 90% of patients, in third decade have fine cortical iridescent opacities, which evolve into visually disabling stellate posterior subcapsular cataract by the fifth decade. c) Atopic dertmatitis About 10% of patients with severe atopic dermatitis develop cataracts in the second to fourth decades. The opacities are often bilateral and may mature quickly. Shield like anterior subcapsular plaque which wrinkles the anterior capsule is characteristic. Posterior subcapsular opacities resembling a complicated cataract may also occur. 3. Traumatic cataract Trauma is the major risk factor for unilateral cataract in individuals. The following risk factors are involved in traumatic cataract, a) Direct penetrating injury to the lens. b) Concussion may cause an imprinting of iris colour on the anterior lens capsule (Vossius ring) as flower shaped cortical opacities (rosette cataract). c) Electric shock and lightening are rare causes. d) Ionizing radiation. e) Infrared radiation- In glassblowers, the IR rays causes exfoliation of the lens capsule which results in thickening of the superficial portion of the capsule and it further splits the deeper layer and protrudes into the anterior chamber. B. Drug induced cataract a) Steroidal drugs may induce cataract. Initially the lens opacities formed in posterior subcapsular region spreads into the anterior region. The relation between dose, duration of administration and the cataract development is unclear. It is understood that children may be more at risk to the cataractogenic effects of systemic steroids and genetic susceptibility may also be of significance. Patients who develop lens physiological changes should have their dose decreased to a minimum, reliable with control of the underlying disease, and if feasible be considered for alternate drug therapy. Premature opacities may regress if therapy is discontinued, alternatively progression may occur despite withdrawn and warrant surgical intervention. b) Chlorpromazine may cause the deposit of innocuous fine, stellate, yellowish brown granules on the anterior lens capsule within the papillary area. The deposition of granular material may accumulate on the corneal endothelium and deep stroma. Both lenticular and corneal deposits are dose -related and irreversible. In very high doses (>2400 mg daily), this drug may cause retinotoxicity. c) Lens opacities may occur due to the irregular use of Busulphan (Myleran) for the treatment of chronic myeloid leukaemia. d) Amiodarone, used in the treatment of cardiac arrhythmias, causes visually inconsequential anterior subcapsular lens deposits in about 50% of patients on moderate to high doses. e) Gold used in the treatment of rheumatoid arthritis, causes harmless anterior capsular deposits in about 50% of patients on treatment for more than 3 years. f) Allopurinol, used in the treatment of hyperuricaemia and chronic gout, increases the risk of cataract formation in elderly patients, if the cumulative does exceeds 400 g or duration of administration exceeds 3 years. C. Secondary cataract A secondary (complicated) cataract grows as a result of some other primary ocular diseases. i. Chronic anterior uveitis is the main cause of secondary cataract. The earliest finding is a polychromatic lustre at the posterior pole of the lens which may not progress if the uveitis is arrested. If the inflammation persists, posterior and anterior opacities developed may progress to maturity. ii. Acute congestive angle closure glaucoma may cause small grey white anterior, subcapsular or capsular opacities within the papillary area. a. Myopia (Pathological) is linked with posterior subcapsular lens opacities and early-onset nuclear sclerosis, which may ironically increase the myopic refractive error. Simple myopia, however, is not associated with such cataract formation. b. Hereditary dystrophies such as retinitis pigmentosa, gyrate atrophy, leper congenital amaurosis and stickler syndrome may be associated with posterior subcapsular lens opacities. Cataract surgery may occasionally improve visual acuity even in the presence of severe retinal changes (Kanski et al., 2003). Free radicals involved in cataractogenesis Free radicals may be formed either by the reduction of molecules by electron transfer or by the haemolytic cleavage of covalent bond. Both these reactions may be enzymatic or non-enzymatic. Due to the presence of an odd unpaired electron in its outermost orbital, these free radicals are unstable and readily react with neighbourhood molecules and extract electrons from them, converting the attacked molecule into a few radical, which in turn attacks another molecule generating more free radicals and so on. This enables free radicals to induce chain reactions that may be thousands of events long. A free radical reaction is terminated by reaction between two free radicals or neutralization by antioxidants (Uday et al., 1999). Fig.5 Pathways of ROS formation C:UsersDHINESHDesktopUntitled 3.png Generation of free radicals Biological free radicals include reactive oxygen species, reactive nitrogen species, reactive sulphur species, free radicals obtained form xenobiotics. a) Superoxide anion radical (O2.-) It is generated from NADPH oxidase and from mitochondria. i) NADPH oxidase is present in the lysosomal cell membranes. It steals electron from O2 resulting in the formation superoxide anion radical (O ·2-). It is converted to hydrogen peroxide and is a spontaneous reaction which is known as respiratory burst. This hydrogen peroxide may react with the chlorine in the presence of myeloperoxidase to form hypochlorous acid or it may produce hydroxyl radicals, by the Fenton reaction which uses the metal ion Fe3+. ii) From Mitochondria: Ubiquionone, which is a terminal acceptor of electron, is converted to semiquinone (free radical). By reacting with O2, it forms (O ·2-) super oxide radical with H2O2, it produce hydroxyl radical ion. b) Hydrogen Peroxide H2O2 SOD It is formed by the dismutation of superoxide by the enzyme superoxide dismutase. O · 2 + O ·2 Hydrogen peroxide is generated from i) Aminoacid oxidases: Flavin is a co-enzyme required for the oxidative deamination of amino acid. The reduced flavin attacks molecular oxygen to form hydrogen peroxide. ii) Xanthine oxidase: Xanthine oxidase catalyses the conversion of hypoxanthine to xanthine and hydrogen peroxide is released from molecular oxygen. iii) Peroxisomes: Peroxisomes is the site of  Ã‚ ¢-oxidation of fatty acids.  Ã‚ ¢- Oxidation of the fatty acids is catalysed by acetyl co-enzyme-A dehydrogenase. During this process, a co-enzyme called FAD which donates two electrons gets reduced to FADH2. Again it is converted to FAD. During that process it gives out O2 and H2O (Kovaceva et al., 2007). c) Hydroperoxyl radical They are highly lipophillic and capable of initiating lipid peroxidation. Lipid peroxidation Lipid peroxidation is a self- perpetuating common process and involves the conversion of lipid components from cell organelles into lipid peroxides resulting in the formation of a pigment known as lipofuscin. Lysosomic reactive oxygen species are formed as a result of complex oxidative chain reactions in mitochondria during energy production. H2O2 formed in smaller amounts by mitochondria pass through walls of lysosome and react with Fe (II) in a reaction known as Fenton reaction to form potent hydroxyl radicals which cause lipid peroxidation (Halliwell, 2001). Malondialdehyde is the major reactive aldehyde resulting from the peroxidation of biological membrane polyunsaturated fatty acids (PUFA). MDA, a secondary product of LPO, is used as an indicator of tissue damage by a series of chain reactions. MDA is a by-product of prostaglandin biosynthesis. It reacts with thiobarbituric acid and produces a red-coloured product. MDA is a mutagenic and genotoxic agent that may contribute to d evelopment of human cancer. Ca2+ ATPase The Ca2+ ATPase is a transport protein in the cells that serves to eliminate calcium (Ca2+) from the cell. It is essential for maintaining the amount of Ca2+ within the cells. Based upon the electrochemical gradient calcium ion enter into the cells through the trans membrane. This process is important for the cell signalling by which it lowers calcium level. Thus it is necessary for the cell to utilize ion pumps to remove the Ca2+. The Ca2+ ATPase is expressed in a variety of tissues, together with the brain (Hightower et al., 1982). IN VIVO MODELS IN CATARACT (Gupta, 2004) 1. Sugar cataract i) Galactose induced cataract The changes associated with galactose cataractogenesis include the initial reduction of galactose into dulcitol through intervention of aldose reductase with NADPH as a co-factor. Accumulation of dulcitol in the lens, (since it is not metabolized) creates cellular hypertonicity associated with and/or followed by a cascade of events, which includes an influx of water, swelling of the lens fibres, epithelial cell edema, damage of plasma membrane, compromise of cellular permeability, a drop in myinositol level, a reduction in Na+ K+ ATPase activity an influx of Na+ and Cl- and an efflux of K+ and the loss of glutathione and aminoacids. These are the morphological, biochemical, enzymatic and molecular alterations in the lens associated with galactose cataracts. ii) Alloxan induced cataract Alloxan is a cyclic urea analog which is highly reactive molecule that is readily reduced to dialuric acid, which is then auto oxidized back to alloxan resulting in the formation of hydroxyl radical, O2.-, including H2O2 (hydrogen peroxide). However, the other mechanism reveals the ability of alloxan to react with protein sulfhydryl groups on hexokinase, a signal recognition enzyme in the pancreatic ÃŽ ²-cells that couples changes in the blood glucose concentration to the rate of insulin secretion. By this mechanism, inhibition of glucokinase and other SH containing membrane proteins on the ÃŽ ²-cells would eventually result in cell necrosis within minutes. iii) Streptozocin induced cataract Diabetes related cataractogenic changes are seen in the animals injected with streptozocin. This streptozocin initiates cytotoxic action in pancreatic ÃŽ ² cells because sreptozocin contain glucose molecule and highly reactive nitrosourea side chain. It binds to the membrane receptor to generate structural damage. At the intracellular level three major phenomena are responsible for ÃŽ ² cell death, i) Methylation ii) Free radical production iii) Formation of Nitric oxide (NO). The damage caused to ÃŽ ² cells alters the sugar metabolism leading to diabetes. 2. Selenite induced cataract Selenite cataract resembles human cataract in many ways such as insoluble protein, vesicle formation, increased calcium, reduced glutathione (GSH) and decreased water-soluble proteins. However, selenite cataract shows no high molecular weight protein aggregation or increased disulfide formation and is dominated by rapid calpain-induced proteolytic precipitation, while senile cataracts may be produced by prolonged oxidative stress. 3. Naphthalene induced cataract Naphthalene is oxidized in the liver initially to an epoxide and then it converted into naphthalene dihydrodiol. This stable component is converted enzymatically into dihydroxynaphthalene to reaching the eye. Being unstable at physiological pH, 1, 2- dihydroxynaphthalene and spontaneously autooxidises to 1, 2- naphthoquinone and H2O2 . It alkylates proteins, glutathione and aminoacids and generates free radicals. 4. Glucocorticoid induced cataract Glucocorticoid cataract results in the formation of steroid- adduct protein, induction of transglutaminase and reduction of ATPase activity may lead to cataract. Steroid cataracts are produced by the activities of glucocorthicoids and progressed by way of production of oxidative stress similar to other types of cataract. 5. L- Buthionine S, R- Sulfoximine (BSO) induced cataract Glutathione is present in mammalian lens in high concentrations and is involved in the protection of lens against oxidation. In most of the cataracts the decrease in its level is observed. 6. Smoke induced cataract Cigarette smoke contains trace and heavy metals. The increased metal contents in lens cause lens damage by the mechanism of oxidative stress-forming oxygen radicals, via metal catalyzed Fenton Reaction. In other words cigarette smoke is associated with the accumulation of iron and calcium. 7. UV radiation induced cataract Epidemiological studies have exposed a link between exposure to UV radiation in sunlight and development of cataract. Experimental studies confirm that ultraviolet (UV) radiation induces cataract. There is, however, a lack of data on the age dependence in experimental UV radiation-induced cataract. 8. Microwave induced cataract Microwave radiation has been reported to produce posterior subcapsular and cortical cataracts in rabbits and dogs within a short span of time. 9. Transforming Growth Factor ÃŽ ² (TNFB) induced cataract TGFB is induced by injecting approximately 60 ng TGFB into the vitreous. TGFB induce lens epithelial cells to undergo molecular modify and abnormal morphologic that mimic the changes observed in human posterior subcapsular and cortical cataract (Gupta, 2004). IN VITRO MODELS IN CATARACT (Gupta, 2004) Induction of cataract in isolated animal lenses maintained in organ culture has become a convenient, quick and appropriate method for testing the anticataract efficacy of an agent. Opacification of lens is induced by generating oxidative stress/ hyperglycemic/ hypergalactosemic conditions around the lens by supplementing the culture medium with a variety of exogenous substances. 1. Oxidative stress induced cataract Oxidative mechanisms play an important role in many biological phenomena including cataract formation. Formation of the superoxide radical in the aqueous humor, lens and its derivatization to other potent oxidants may be responsible for initiating various toxic biochemical reactions leading to the progress of cataract. In vitro such cataracts are induced by agents like selenium, H2O2, photosensitizers and enzyme xanthine oxidase. 2. Selenite induced cataract In vitro cataract is produced by supplementing the tissue culture medium with 25 to 100 mM sodium selenite in which freshly enucleated transparent rat lenses are incubated at 370C. This causes membrane damage and faint cortical opacities within 24 h. 3. Photochemically induced cataract Riboflavin, a photosensitizer, is supplemented in the culture medium to induce cataract in cultured lenses. Micro quantities (4-200  Ã‚ ­M) of riboflavin lead to severe physiological damage and opacification within 24 h after exposure to light. The initial membrane damage is evidenced by a disturbed cation ratio between lens water and the medium of incubation. Riboflavin on getting photosensitized generates free radicals in a sequence of reactions. Lenses are maintained in organ culture for 24 to 72 h. The lenses are divided into four groups and incubated in the dark and light both in presence and absence of riboflavin. The lenses are exposed to light with two 15-w daylight fluorescent lamp placed at 8 inches above the cluster plate. The culture medium is replaced every 24 h. Riboflavin shows no effect on the lens in the absence of light, and light without riboflavin has no significant effect. opacification starts in the equatorial zone and gradually extends towards the centre of the lens. 4. Enzymatically induced cataract Supplementation of culture medium with 1 mM xanthine and 0.1 unit xanthine oxidase, which act as substrate and enzyme respectively, leads to generation of superoxide radical. The lenses suffer severe oxidative damage and turn opaque within 24 h when incubated in culture medium at 370C. 5. Hydrogen peroxide induced cataract Incubation of lenses in medium containing 50-500  Ã‚ ­M H2O2 and it produce cataract. Opacification starts in the equatorial region within 24 h. The entire superficial cortex becomes opaque by 96 h. Due to the high instability of H2O2, the medium is changed every 2 h during the first eight hours. 6. Sugar induced cataract Transparent and undamaged lenses are incubated in a basis culture medium with fetal calf serum for 24 to 48 h. In the control group the medium is supplemented with glucose (30 mM), lenses develop opacity in the subcapsular region on day 1 and in the central region on day 2. Biochemical analyses reveal raised polyol, malondialdehyde levels and water content, and decreased glutathione levels in these lenses. 7. Steroid induced cataract Steroid-induced experimental cataract is produced in vitro by incubating the transparent lenses in the medium containing methyl prednisolone (1.5 mg/ml). The test agent and methyl prednisolone added alone and together to the medium form drug control, control and treated groups respectively. Early cataract around the equator is produced within 24 h of incubation. Incubation period may be extended to 48 h for dense opacity. Morphological changes and modulation in biochemical parameters between the groups may show the potential of the anticataract agent. 8. Naphthalene induced cataract TC-199 medium is used for the preincubation of lens. Stock solution of napthalene dihydrodiol is prepared in 20% ethanol at 2.5-10-3 M concentration. The stock solution is diluted 1:100 to obtain the final concentration of 25.5 -10-5 M. The final osmolarity of the solution is 295-300 m Osmol. Rat lenses are incubated in TC-199 medium containing napthalene metabolite solution. Medium is renewed daily till 72 h. Lenses remain clear during the initial 24 h but from shell-like opacity around the nucleus by 48 h. Opacification becomes more peripheral and widespread after 72 h. At 48 h, under such conditions of incubation, development of opacity mimics the in vivo napthalene cataract. Naphthalene is oxidized in the liver first to an epoxide and then is altered into naphthalene dihydrodiol. This stable component on reaching the eye gets converted enzymatically to dihydroxynaphthalene. Being unstable at physiological pH, 1,2 dihydroxynapthalene sponaneously auto oxidises to 1,2 naphthoquinon e and H2O2. It alkylates proteins glutathione and amino acids and generates free radicals. There is a loss of protein thiol in this reaction and the products are less easily digestible by pancreatin than normal lens protein (Rees and Pirie, 1967). 9. Ca2+ induced cataract In this model, the control group contains the lenses incubated in the medium enriched with 20 mM Ca2+ or 1x 10-2 mM A23187 calcium ionopore. The treatment group lenses are cultured in the calcium and the test drug-containing medium. Incubation period can range from 24-72 h (Gupta, 2004). Fig.6 Mechanism of action of glucose-induced cataract C:UsersDHINESHDesktopUntitled 7.png Under physiological conditions, glucose is metabolized through the glycolytic pathway. An excess amount of glucose is converted to sorbitol by enzyme aldose reductase via polyol pathway. The glucose conversion into sorbitol by utilizing NADPH results in the reduction of NADPH/NADP+. Moreover, sorbitol undergoes oxidation to fructose by using sorbitol dehydrogenase (SD). Sorbitol does not easily cross cell membrane. Intra lenticular accumulation of sorbitol, leads to lens damage (Kyselova, 2004). Fig.7 Biomorphological changes during cataract formation C:UsersDHINESHDesktopUntitled 66.png As, the lens starts to swell in response to the hyper osmotic effects of polyol accumulation, membrane permeability changes resulting in an increase in lenticular sodium and decrease in the levels of lenticular potassium, reduced glutathione, ATP and free amino acids. The overall antioxidant status of the lens decreases because of depletion of GSH (Kyselova, 2004). Mechanism of action of calcium-induced cataract Fig.8 Calcium transport pathway Increased levels of lenticular calcium activate calcium dependent proteases. The activated proteases hydrolyze cytoskeletal proteins and lens crystalline. Crystalline cleavage would result from lower molecular weight peptides that could, in turn, aggregate to form higher molecular weight proteins (Wang et al., 1996). Various methods for the prevention of cataract The development of newer drugs for treatment of cataract mainly aims, interacting at the level of changed lens metabolism and lens pathophysiology. The in vitro, in vivo studies are used to identify the anti cataract agents. This epidemiological studies may be widely classified in the following categories (Gupta et al., 1997). Aldose reductase inhibitors Agents acting on glutathione Nonsteroidal anti -inflammatory drugs Vitamins, minerals and antioxidants Miscellaneous agents. 1) Aldose Reductase Inhibitors These drugs are aimed to prevent the metabolic dysfunctions of diabeties by polyol pathways. Aldose reductase inhibitors prevents the accumulation of sorbital within the lens would have an osmotic effect bringing in water and causing swelling and opacification. Sorbinil a spirohydantoin became the most powerful sorbitol lowering agent. Sorbinil prevents increased fluorescence and protein aggregation and it also acts as an antioxidant. 2) Non Steroidal Anti inflammatory Drugs The NSAIDS broadly studied are paracetamol, aspirin, Ibuprofen, sulindac, naproxen, and bendazec. The NSAIDS provide adequate productive effect to lens protein through various steps like acylation, carbamylation and inhibition of glycocylation. Some of them are also reported to inhibit lens AR to varying extent. NSAIDS contains antioxidant properties also. Most of the studies on the evaluation of anticataract potential of drugs have been conducted by feeding the drugs by oral route. 3) Agents which act on glutathione Glutathione is a tripeptide thiol known to control calcium inflex and protect lens protein from various agents like glucose and galactose. With advancing of age there is a considerable decrease in the concentration of glutathione and the decrease more prominent in lens with cataract. 4) Vitamins, minerals and antioxidants If oxidation in lens leads to cataract formation, then is feasible to prevent it by the use of antioxidants such as vitamins C and E and perhaps ÃŽ ²-carotene. The potential role of vitamins and antioxidants in preventing various diseases is well documented there are reports suggesting beneficial effect of vitamins like C and E in preventing cataract. Beta -carotene has also been demonstrated to protect lens damage by hematoporphysin. Ascorbate protects rubidium uptake against free radical damage and prevents light induced protein cross linking. Protective effect of vitamin C has been also reported in various in vitro studies. Vitamin E has been found to delay cataractogenesis in diabetic rats and in Emory mouse. Vitamins C and E,  Ã‚ ¢- Carotene and other anticataract agents probably act via a common mechanism of their scavenging properties of free radicals (Gupta et al., 1997b). Antioxidant enzymes 1) Superoxide Dismutase (SOD) SODs are a family of metalloenzymes that transfer superoxide in to hydrogen peroxide (H2O2) and represents the first line of defence against oxygen toxicity. 2O2- + 2H → H2O2 + O2 Three isoforms of SOD have been found. The first is mainly found in the cytoplasm of cells and it containing Cu and Zn at its active site (Cu/Zn SOD-1), the second containing Mn at its active site is located in mitochondria (Mn SOD-2) and the third (Cu/Zn SOD-3) is present in the extracellular fluid like plasma. SOD is a stress protein which is synthesized mostly in response to oxidative stress. It is found that little amount of Cu, Zn and Mn metals are crucial for maintaining the antioxidant activity of SOD (Halliwell, 1994; Ray and Husain, 2002). 2) Glutathione Peroxidase (GPx) GPx is one of the most important enzymes responsible for the degradation of organic peroxides and hydrogen peroxide in the brain. GPx catalyse the oxidation of GSH to GSSG at the expense of H2O2. There are two isoforms have been identified, selenium-dependent which is highly active towards H2O2 and organic hydroperoxides and selenium independent GPx. GPx activity has been reduced in selenium deficiency (Muller et al., 1984; Son et al., 2007). 3) Catalase (CAT) It is a heme-containing protein present in most cells. 2H2O2+ 2H2O → O2 Catalase is 104 times faster than GPx. It is having four protein subunits, each containing a heme Fe (III)-protoporphyrin group bound to its active site. GPx and CAT were found to be important in the inactivation of many environmental mutagens (Ray and Husain, 2002). 4) Glutathione (GSH) GSH has major intracellular antioxidant molecule and it is a tripeptide synthesised by enzymatic reaction involving two molecules of ATP from aminoacids like glutamate, glycine and cysteine. It plays a very crucial role in detoxification of peroxides and electrophilic toxins, mainly by acting as a substrate for GSH transferase and GSH peroxidase. It was shown that weakening of GSH enhances cerebral ischemic injury in rats (Mizui et al., 1992; Son et al., 2007).

Prevalence of Coronary Heart Disease in India

Prevalence of Coronary Heart Disease in India Introduction According to WHO (2007) coronary heart disease (CHD) (including Myocardial ischemia) is the most common cause of death in the world and the biggest cause of premature death in modern and industrialised countries (Lopez et al., 2006; Lindsay and Gaw, 2004). In 2001, ischemic heart disease accounted for 7.1 million deaths worldwide among which 5.7 million (80%) deaths were in developing and underdeveloped countries (Lopez et al., 2006). Although geographical variations such as ethnic origin and social class influence the CHD mortality rates (Lindsay and Gaw, 2004), coronary heart disease remains common globally despite the development of a range of treatments (Brister et al., 2007). There is evidence that ethnicity is an important factor for coronary heart disease (Gupta et al., 2002; Brister et al., 2007) and a number of studies have suggested that there is increased incidence in coronary artery disease in South Asians (people originating from India, Pakistan, Bangladesh and Sri Lanka) when compared to the white population (Brister et al., 2007). South Asian people also have a greater risk of coronary heart disease than others from developed countries (Mohan et al., 2001; Joshi et al., 2007). In 2002 India had the highest number of deaths over 1.5 million due to coronary heart disease (Reddy et al., 2004). By 2010, it is expected that 66% of the worlds heart disease is likely to occur in India (Ghaffar, 2004). Therefore, this dissertation will focus on the prevalence of CHD in India and the impact of life style in the aetiology of CHD. There is wide range of evidence regarding the incidence and prevalence of coronary artery disease (CAD) in India (Reddy, 2004; Kasliwal et al., 2006; Patel et al., 2006; Brister et al., 2007), including Indian, British and Singaporean journal articles. This dissertation is broken down into three parts: the first discusses the topic in relation to the existing literature on the prevalence of CHD in India; the second part is a critical appraisal of the risk factors and the impact of life style of CHD in Indians; While the third presents the management of CHD, and includes a discussion of the nursing implications and future research into this area. Background THE DISEASE ASPECT- CORONARY HEART DISEAS/CORONARY ARTERY DISEASE Definitions Coronary heart disease â€Å"CHD covers a spectrum of disease such as angina, acute coronary syndrome, myocardial ischemia, ischemic cardiomyopathy, chronic heart failure and a proportion case of sudden cardiac death† (Lindsay and Gaw, 2004 pg no. 1). Acute coronary syndrome This is the clinical entity of myocardial ischemia and myocardial infarction. Myocardial Infarction â€Å"it is a condition that results from diminished oxygen supply coupled with inadequate removal of metabolites because of reduced perfusion to the heart muscle† (Woods et al., 2005 pg no. 541) Angina â€Å"A condition characterised by chest pain or discomfort from myocardial ischemia† (Woods et al., 2005 pg no. 541) Overview of Coronary Artery Disease CHD is the major cause of death in most countries and is considered almost to be an epidemic in western countries (Lippincott, 2003). In Britain it accounts for one in three deaths in men and one in four deaths in women, while 5,000,000 deaths annually are seen in US (Forfar and Gribbon, 2000). It is estimated that more than 80% of patients who develop clinically significant coronary artery disease (CAD), and more than 95% of those who experience a fatal CAD event have at least one major cardiac risk factor (Greenland and Klein, 2007). CHD is more prevalent in males, whites and the middle-aged, as well as elderly people. More than 50% of males age 60 or older show signs of coronary artery disease on autopsy. The peak incidence of clinical symptoms in females is between ages 60 and 70 (Lippincott, 2003). There is a marked difference in death rates due to coronary disease between countries: for example, a 10-fold greater age-standardized death rate for men aged 35 to 74 years in Scotland compared with Japan. Within Europe, a threefold difference in death rates and disease incidence can be seen with Finland and the United Kingdom higher than Italy, France, and Spain (Forfar and Gribbon, 2000). There are also marked contrasts in coronary disease mortality trends between developed and developing countries. In the United States, Western Europe, and Australia, mortality has been falling between 15 and 50 per cent for at least 20 years (Lippincott, 2003). In contrast, rates continue to rise in Eastern Europe, including Poland, Hungary, Bulgaria, and the Czech Republic. The fall could be due to a fall in disease incidence or case fatality rates, or both. Although the management of acute myocardial infarction in particular has improved over this time, with case fatality rates halved, there ha s also been an increased awareness of risk factor avoidance (Forfar and Gribbon, 2000). The Disease aspect Coronary arteries bring blood and oxygen to nourish the heart. The heart pumps deoxygenated blood to the lungs, where it receives oxygen before it is pumped to the whole body. Because the heart is a muscle, it needs a continuous source of oxygenated blood to function. Causes and symptoms CHD is usually caused by atherosclerosis. Cholesterol and other fatty substances accumulate on the inner wall of the arteries, which in turn attracts fibrous tissue, blood components, and calcium to the inner walls of the arteries which then hardens into artery-clogging plaques (Woods et al., 2003). Atherosclerotic plaques often form blood clots that also can block the coronary arteries (coronary thrombosis). Congenital defects and muscle spasms can also block blood flow. Recent research indicates that infection from organisms such as the chlamydia bacteria may also be responsible for some cases of coronary artery disease (Warrel, 2003). A number of major contributing factors increase the risk of developing coronary artery disease. Some of these can be changed and some cannot. People with more risk factors are more likely to develop coronary artery disease. Major risk factors Major risk factors are those factors that lead to CHD. They are mainly classified into two groups: non-modifiable and modifiable (Lippincott, 2003). Those that cannot be changed are the non-modifiable risk factors such as: Heredity if a persons parents have coronary artery disease he/she is more likely to develop it. Sex Men are more likely to have heart attacks than women and to have them at a younger age. Age Men 45 years of age and older and women 55 years of age and older are more likely to have coronary artery disease. However now-a-days, coronary disease may occasionally strike a person in their 30s (Lippincott, 2003). Major risk factors that can be changed (modifiable risk factors) are: Smoking Smoking increases the chance of developing CHD and the chance of dying from it. High cholesterol Dietary sources of cholesterol are meat, eggs, and other animal products. There are other factors also that increase the cholesterol level such as age, sex, heredity, and diet affect ones blood cholesterol. Total blood cholesterol is considered high when it is above 240 mg/dL and borderline at 200-239 mg/dL. High blood pressure High blood pressure makes the heart work harder, also increases the risk of heart attack, stroke, kidney failure, and congestive heart failure. A blood pressure of 140 over 90 or above is considered high. Lack of physical activity Lack of exercise increases the risk of coronary artery disease. Even modest physical activity, like walking, is beneficial if done regularly (Lippincott, 2003). Diabetes mellitus the risk of developing coronary artery disease is seriously increased in diabetics. More than 80% of diabetics die of some type of heart or blood vessel disease. Chest pain (angina) is the main symptom of coronary heart disease but it is not always present. Other symptoms include shortness of breath, and chest heaviness, tightness, pain, a burning sensation, squeezing, or pressure either behind the breastbone or in the arms, neck, or jaws (Lindsay and Gaw, 2004). Many people have no symptoms of coronary artery disease before having a heart attack: according to the American Heart Association 63% of women and 48% of men who died suddenly of coronary artery disease had no previous symptoms of the disease (Woods et al., 2001). THE COUNTRY PROFILE INDIA The country India India, situated in the South Asian region, is the seventh largest, and the second most populous, country in the world with a population of 1.103 billion (United Nations Population Division, 2005) in 32 states and union territories covering about four thousand towns and cities and about six lakhs villages (Nag and Sengupta, 1992). The population distribution is 71% rural and 29% urban (United Nation Population Division, 2005). Initially, India was a rural economy that subsequently participated in the industrial revolution with the help of colonial rule. After independence in 1947, the country followed socialist policies and hence large-scale infrastructure and industry development was carried out through the public sector. By the early 1990s, the Indian economy was opened up through liberalization and is now on the road to privatization through disinvestment policies. However, the economic growth in India during the 1990s as a result of the 1991 economic reforms has also seen an increase in poverty and a radical transformation in the well-being of the bottom half of the population (Rajeshwari et al., 2005). The consequences of these economic and social changes have led to an epidemiological transition (Joshi et al., 2006). An epidemiological transition is a focus on the complex changes in the patterns between the health and disease and the interaction between them and various other factors such as demograp hic, economic and determinants with their consequences (Omran, 2005). The urban population has increased by 4.5 times during 1951-2001 (WHO, 2000). The life expectancy from birth for males is 62 and females 64 (WHO, 2008). While the crude mortality rate is decreasing the percentage of children under 15 is declining (WHO, 2007). Total expenditure on health per capita (Intl $, 2006): 109. Total expenditure on health as % of GDP (2006): 4.9 (WHO, 2008). The leading cause of mortality after death during childbirth is cardiovascular disease, accounting for 188 deaths per 100,000 population (WHO, 2005). The health care system of India is overseen by two different bodies: The Department of Health Family Welfare. The Department of AYUSH (Ayurvedic, Unani, Siddha and Homeopathic Medicines). Each state has a Ministry of Health Family Welfare although their organization differs from state to state. Generally, there is a Directorate of Health Services providing technical assistance. Some states have a separate Directorate of Medical Education Research, and some have a separate Director of Ayurveda or Director of Homeopathy (WHO, 2007). In rural areas, Community Health Centres serve estimated populations of 100,000 and provide speciality services in general medicine, paediatrics, surgery and obstetrics gynaecology. However, there is still a shortfall in the number of community health centres in the rural areas of India. A Primary Health Centre (PHC) covers around 30,000 people (20,000 in hilly, desert or difficult terrain) and is staffed by a medical officer, and one male and one female health assistant along with supporting staff. A sub-centre serves around 5,000 people (3000 in difficult terrain) and is supported by one male and one female multipurpose health worker. T hese workers and health assistants have different designations in different states. Playing an equally important role in curative and preventive care in urban areas is the private sector. A large number of private practitioners exist and there are many large and small hospitals and nursing homes along with a large number of voluntary organizations providing health care (Bhat, 1993). Chapter One: Literature Review Aims The aim of this review is To analyze the prevalence of CHD in India To analyze the mortality rates related to CHD To understand the aetiology of CHD in India This review will also include a comparison study of the prevalence of coronary heart disease among migrant Indians and the natives of the particular migrant destination countries. Reason for the selection of the topic CHD remains the largest cause of death worldwide. Mortality rates from cardiovascular disease have been known to increase from five-fold to ten-fold around the world (National Institute of Health, National Heart, Lung and Blood Institute, 2000). A World Health Organisation (WHO) Multinational monitoring of trends and determinants in cardiovascular disease (MONICA) study analysed the event rates of CHD among 38 populations between the age group 35-64years, and found variations in CHD prevalence and mortality rates among different ethnic groups (Tunstall-Pedoe et al., 1994). India is a developing country which is seeing an increased rise and prevalence of CHD (Reddy, 2004). While the incidence of coronary artery disease (CAD) has decreased by 50% over the past 30 years in developed countries, in India it has doubled (Kasliwal et al., 2006). Prevalence is an epidemiological measure to determine a how commonly disease or condition occurs in a population, whereas incidence is another epidemiological measure that measures the rate of occurrences of new case of a disease or condition (Le and Boen, 1995). The prevalence of CHD is seen mostly from the age of 35 years and over (Kasliwal et al., 2006). CHD is the second leading cause of mortality in Indians (Patel et al., 2006). Joshi et al., (2006) conducted a survey in the rural areas of Andhra Pradesh, India, the results of which suggested that vascular diseases (including ischemic heart disease and stroke which accounts for 32%) are the main cause of mortality in India when compared to other chronic conditions such as infectious and parasitic diseases, tuberculosis, intestinal conditions, HIV, neoplasm and diseases of the respiratory system. However, CHD mortality rates have decreased in by 50% in most industrialised countries since 1970s (Unal et al., 2004). In United States the decline was seen during the 1980s (US Department of Health and Human Services, 2000), while in the United Kingdom the decline saw a slower pace (British Heart Foundation, 2003). In the United Kingdom the death rates fell by half in the 55-64 age group and slightly less than 40% in men aged 35-44. In women death rates fell by half and a third in those aged 55-64 years and 35-44 respectively (British Heart Foundation- BHF, 2004). However, even though the mortality rates from CHD have fallen it does not suggest that the prevalence has also fallen. The reasons for the decline are not clearly understood but some hypothesise that a reduction in smoking; management for lipid and blood pressure control; modern care for acute coronary syndrome; and secondary prevention has contributed (Luepker, 2008). The increased incidence of CHD has led to the increase in number of Coronary Artery Bypass Grafts (CABG) and other cardiac surgeries. It is estimated that 25,000 CABG surgeries are carried every year in India (World Health Organisation Statistical Information System, 2003). Hence, it could be noted that in a highly populous country like India with its increased prevalence of CHD that the estimated CABG surgeries reaching to the public is actually very few. Therefore, there could be considerable gap between the public need and treatment. Therefore, the reason for this thesis is to help us understand that there is high prevalence in CHD in the Indian population; the specific reasons for this increased epidemic; and how can it be managed so the population can remain healthy. Search strategy The literature was searched with the specific intention of examining the most up-to-date data concerning the prevalence of CAD in India. The search was performed by accessing specialised scientific medical and nursing databases carrying articles regarding the specified subject area (Craig and Smyth, 2002). The databases accessed included the Cumulative Index of Nursing and Allied Healthcare Literature (CINAHL), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and MEDLINE and EMBASE using the Ovid SP interface. The keywords used for the search were: coronary artery disease, ischemic heart disease, and coronary heart disease, South Asians, prevalence, mortality rate, British white, Caucasians and India. The Boolean term AND was used simultaneously. The date range of the studies targeted was set between 1991 and 2009; and was chosen so the most recent evidence could be drawn on, although articles outside this date limit were also incorporated into the search so as to be able to compare whether there have been any changes in the literature over time. To focus the search more strategically the following inclusion and exclusion criteria below were applied. Inclusion and exclusion criteria used to narrow the search The inclusion criteria include prevalence of CHD in both rural and urban areas in order to compare the prevalence of CHD, the date range was set from 1991-2009 so that the recent evidence could be drawn on. The other inclusion criterions were British Indians, American Indians, migrant Indians and South Asians. The patient age group considered was from 35 years over as this matches the known incidences of coronary artery diseases (Kasliwal et al., 2006). The exclusion criteria were other cardiovascular studies such as peripheral artery disease since the literature review focussed on CAD only. Search Results Initially the search revealed 78 potentially relevant papers; however 48 did not contain data pertinent to the inclusion criteria or were not credible sources. The 30 papers that were used for the review included both qualitative and quantitative studies. They included a wide range of international literature to allow a comparison of the prevalence of CHD between British Indians and British whites. The literature that provided evidence from the Indian health care system were all medical journal articles by authors such as Bhardwaj, 2009; Mandal et al., 2008; Kamili et al., 2007; Chow et al., 2006; Patel et al., 2006; Kuppaswamy and Gupta, 2005; Patel et al., 2005; Sharma and Ganguly, 2005; Ward et al., 2005; Indrayan, 2004; Pinto et al., 2004; Gupta et al., 2003; Gupta and Rastogi, 2003; Gupta et al., 2002; Singh et al., 1997; Gupta et al.s 1997; Dhawan, et al 1996; Gupta et al., 1995; Gupta et al., 1993; Kutty et al. 1992. Journals from UK include Zaman et al., 2008; Whincup et al., 2002; Bhopal et al., 1999; Cappuccio et al., 1997; and Journal from Singapore are Mak et al., 2004; Tai and Tan, 2004; Kam et al 2002; Lee et al., 2001. From the analysis of the above literature the following themes were formulated The prevalence of CHD in the mother country, India, both in rural and urban areas. The reasons for the increase in CHD in India. A comparison of CHD prevalence and mortality rate between British Indians and British whites. Credibility of the Literature In order establish the evidence of increased prevalence of CHD in India it is necessary to analyse a wide range of literature. To assess the credibility and reliability of the evidence, the strengths and limitations of the texts were identified. Systematic reviews were used to determine the strength of the evidence. In the hierarchy of evidence, systemic reviews are considered the golden standard. This is because systemic reviews draw on â€Å"Statistical procedure[s] for combining data from a number of studies and investigations in order to analyse the therapeutic effectiveness of specific treatment or interventions.† (Helewa Walker, 2000, p.111). There was only one systematic review available for this literature review (Bhopal et al., 2000). This research paper has a clear search strategy stated, limits, and selection criteria. The search was limited to English research papers, however one exception was that only published studies reporting original comparative data were included. Unpublished studies and studies only reported as abstracts were not included, which ensures rigour in the analysis of the data by having a complete recount of the different studies; this also ensures that the studies had gone through an evaluation committee before being published. The conclusions reached in the systematic reviews support the conclusions reached across the other literature sourced (Mandal et al., 2008; Gupta et al.,1997). Observational studies are considered a good source of evidence, and are similar to Randomized Controlled Trials (RCTs) in terms of effectiveness, appropriateness, and feasibility of the evidence (Craig Smith, 2002). The studies examined as part of this essay also described the setting, location, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection, thereby increasing their robustness (STROBE checklist, 2008). There was one observational study that mentioned its location, time period and setting, and therefore provided credible evidence for the literature review (Wilkinson, 1996). Most of the studies analysed for the literature review were population based surveys, while some studies were clearly addressed and statistically analysed (Mandal et al., 2008; Zaman et al., 2008; Chow et al., 2006; Patel et al., 2005; Mak et al., 2003; Whincup et al., 2002; Lee et al., 2001; Bhopal et al., 1999; Cappuccio et al., 1997, Gupta et al., 1997; Singh et al., 1997; Kutty et al., 1992) ethical issues were mentioned (Cappuccio et al., 1997; Kutty et al., 1992). Some studies however did not explain their statistical analysis (Bhardwaj, 2009; Pinto et al., 2004), and without knowing the specific characteristics of the statistical analysis, the studies cannot be replicated as evidence in this literature review. In regard to qualitative research, a great deal of debate is still going on regarding how to assess the quality of such work (Sandelowski, 1986). In particular, researchers suggest that it is difficult to develop a single benchmark against which the true value of claims can be judged (Craig Smith, 2002). Even though qualitative studies are not considered excellent or even good sources of evidence, based on evidence-based hierarchy, they can address questions that cannot be answered using other experimental methods (Green Britten, 1998). One qualitative study in the literature was used to examine and compare the illness beliefs of South Asian and European patients with coronary heart disease (CHD) about causal attributions and lifestyle change. The method of sampling and data analysis was appropriate. Although the reviews of the literature accessed for this literature review did not prove as rigorous as other sources of evidence, because they did not draw on empirical data, they were used to support the findings of other more robust forms of evidence, which were generated from systematic reviews, observational studies and survey. Reviews of the literature carried out by Goyal and Yusuf, 2006; Kuppaswamy and Gupta, 2005; Sharma and Ganguly, 2005; Tai and Tan, 2004; Barakat et al., 2003; Yusuf et al., 2001; Reddy et al., 1998 provided evidence, however the paper fails to present a search analysis. Evaluation of key studies The prevalence of CHD in India Coronary heart disease has emerged as an epidemic in India (Gupta and Rastogi, 2003). According to the National Commission and Macroeconomics and Health, Government of India the total number of CHD patients in India by the end of the century was around 30 million (5.3% ) of the adult population; this is forecast to increase to up to 60 million cases (7.6%) by the year 2015 (Indrayan, 2004). Although there are various comparative studies showing the burden of cardiovascular disease among Indian immigrants in Western countries, there has been less attention paid to CHD in India itself (Goyal and Yusuf, 2006, Reddy et al., 2004, Yusuf et al., 2001, Anand et al., 2000). Hence, this section of the literature review will focus on the prevalence of CHD in India. In developed countries, there are no rural-urban differences in the prevalence of CHD (Feinleib, 1995). However in India there is marked difference between the prevalence of CHD in the rural and urban areas with surveys showing that the prevalence rate of CHD in urban areas is about double that rural areas (Gupta et al., 2006; Reddy, 1998; Singh et al., 1996; Singh et al., 1997). Studies have been done in various states of India of the prevalence of CHD in the country. For example, Mandal et al., (2008) conducted a cross-sectional survey among the urban population of Siliguri in West Bengal, from a random sample population aged greater than or equal 40 years, to determine the prevalence of ischemic heart disease and the associated risk factors. The results showed that 11.6% had ischemic heart disease (IHD) and 47.2% had hypertension. Males had a higher (13.5%) prevalence of IHD than females (9.4%). About 5% of the patients had asymptomatic IHD. However, this study had a small sample size, which could limit the generalisability of the findings and is limited by the fact that other risk factors like diabetes and lipids were not included. On the other hand, Kutty et al. (1992) conducted a survey among the rural population of Thiruvananthapuram district in Kerala state, to analyse the prevalence of some indicators of coronary heart disease. The indicators included in the study were ECG changes and well-known risk factors such as obesity, hypertension, smoking and diabetes. From the above criteria it was found that rural Thiruvananthapuram has a lower prevalence of coronary heart disease when compared to urban centres like Delhi. However there were drawbacks to this study too, such as the fact that people were sampled on the basis of household list from the panchayat office (panchayat is south Asian rural political system) so anyone who did not belong to the house list in the panchayat was not included in the study. This could have caused a limitation in the generalisability of the results as there was bias in sampling technique. Similarly, Singh et al., (1997) conducted a cross- sectional survey in two villages in Northern India, which showed a significantly higher and increased prevalence of CHD in urban areas compared to rural areas. Reddy also (1998) conducted a cross-sectional survey which found the prevalence rate of CHD as being 6% in the rural areas of Haryana, India. Another study conducted was in the rural areas of Northern India in Himachal Pradesh which showed a CHD rate of 4.06% among the whole rural population in the age group between 50-59 years with a slightly higher incidence in men than women (Bhardwaj, 2009). However these research papers failed to set out their statistical analysis or research analysis, meaning that the reliability of the papers cannot be measured. Nonetheless, it can be noted that the prevalence of CHD was lower in the rural areas and also that the prevalence rates varied in different states of India. Chow et al., (2006) conducted a survey in the rural areas of Andhra Pradesh to investigate the prevalence of cardiovascular disease and levels of managing the major risk factors. Their results showed that cardiovascular disease is highly prevalent and the community knowledge about cardiovascular disease is quite good. However, the results also pointed out that even though people have the knowledge, their management for risk factors remains suboptimal. Hence it could be suggested that even though the people had good awareness regarding CHD the care provided for them was insufficient. Additionally there were a number of studies done to determine the increase in CHD prevalence in urban areas compared to rural areas of India (Pinto et al., 2004; Gupta et al., 2002; Gupta et al., 1995). However there are limitations to these studies, including such factors as: small and variable samples, low response rates, inappropriate diagnostic criteria, non-specific electrocardiographic changes, a lack of standardization, or incomplete results. Gupta et al.s (1997) survey in a rural area (Rajasthan) found that even though the prevalence of CHD was lower in the rural areas, it had nevertheless increased (to 3.4% in males and 3.7% in females) when compared to previous studies. The study was carried out with a detailed questionnaire prepared according to guidelines from the World Health Organization (WHO) the United States Public Health Service and a based on a review of previous Indian studies. The Performa elicited: family history of hypertension and CHD; social factors such as education, housing, type of job, stressful life events, depression, participation in religious prayer and yoga; along with conventional risk factors such as smoking, alcohol intake, amount of physical activity, diabetes, and hypertension. Blood pressure measurements and a 12 lead ECG using proper standardization were performed on all participants. Earlier studies from India used different criteria and showed higher CHD prevalence. When the diagnostic criteria in the present study are extended to include past documentation, response to WHO-Rose Questionnaire and ST-T wave changes in ECG as done in previous studies, the prevalence rises to a rate higher than those found in previous Indian rural studies. However, the results cannot be validated. For example, some of the previous studies from India included ECG criteria as the presence of left bundle branch block, complete heart block and presence of ST segment and T wave changes while some studies suggest that these findings are not reliable enough to diagnose CHD, especially so in females where ST-T changes may be non-specific (Reddy et al., 1996; Gupta et al., 1993). That said, it is clear evidence that there is still an increasing prevalence of CHD in India. Heart diseases are also occurring in Indians 5 to 10 years earlier than in other populations around the world (Dhawan, et al 1996). According to the INTERHEART study, the median age for first presentation of acute Myocardial Infarction (MI) in the South Asian (Bangladesh, India, Nepal, Pakistan, Sri Lanka) population is 53 years, whereas that in Western Europe, China and Hong Kong is 63 years, with more men than women affected (Yusuf et al 2004) (the INTERHEART study was a standardized case-control study that screened all patients admitted to the coronary care unit or equivalent cardiology ward for a first MI at 262 participating centres in 52 countries throughout the world). Epidemiological studies have shown that immigrant Indians share a significantly higher incidence of CHD than the native populations (Enas et al., 2005; Gupta et al., 2002). The first evidence of this was found in a 1959 study among expatriate Indians in Singapore (Kuppaswamy and Gupta, 2005). Similarly many studies have been done in various other countries to corroborate these findings (McKeigue, 1991; Enas et al., 2005). However, in the UK it is only recently that the importance of ethnicity and disparities in regard to CHD has been realised (British Heart Foundation, 2004). Several studies have reported that there is increased prevalence of CHD in British Indians when compared to British Whites (McKeigue, 1991; Bhopal et al., 1999; Enas et al., 2005). Hence, the review of the literature clearly shows the prevalence of CHD among the urban and rural populations in In